The Growing Emergence of Telehealth

The United States spends
more on healthcare than any other developed country in the world. In 2015, the United States spent an estimated $9,523 per person on healthcare, which accounts for approximately seventeen percent (17%) of the
Gross Domestic Product. Contrary to how much the country spends on healthcare
per capita, twenty percent (20%) of Americans reside in areas thatexperience physician shortages, and the United States
is still lacking in health care efficiency and patient access to
care. To improve the country’s position
in healthcare delivery, a growing phenomenon has emerged in the field of
healthcare known as telehealth (also known as telemedicine).

Telehealth is the use of
technology, specifically electronic devices, to deliver healthcare services
through the exchange of medical communication between the physician and
patient. One outlet utilized in telehealth is applications on a patient’s smartphone, including
applications such as Live Health Online, First Opinion, Health Express, and Stat
Doctors, which a patient can use to communicate with physicians and exchange
healthcare information.Such
applications foster a one-on-one interaction between the physician and patients
without the physical contact of in-person physician
visit. The services provided via
telehealth are threefold: store-and-forward services, real-time communication,
and remote patient monitoring. Store-and-forward services entail the transmission
of medical data for a physician’s assessment at a later time. This type of
service is best for diagnosis and treatment recommendation purposes. Real-time communication deals with the use of audio and visual
equipment to simulate a typical physician appointment with the patient and physician
viewing each other through some form of electronic device. Remote patient monitoring relates to the tracking
of a patient’s health status once they are released, or admitted to a healthcare
facility, with the goal of reducing readmission rates.

Telehealth can bring several benefits to the
healthcare field. First, telehealth can increase
healthcare access for patients in rural areas where there are fewer physicians.
Through real-time communication patients have the opportunity to access
physicians without requiring the physicians to physically meet patients. This reduces time and resources spent by both parties on
consultation.Second, due to remote
patient monitoring via electronic devices, chronic disease patients may
potentially receive better care.Remote
monitoring enables physicians to more thoroughly monitor patients thus
potentially reducing hospitalizations and lengths-of-stay, as well as assuring
that patients adhere to their medications. Telehealth, therefore, creates avenues for
healthcare practitioners to dedicate more time to patient treatment. Some commentators have pointed to telehealth
being a means to reduce health care spending. Using remote patient monitoring to reduce
unnecessary tests and visits alone is expected to create savings of up to $3.61 billion. Additional savings can be achieved through a
reduction of referrals to outside specialists from emergency departments because
specialists are able to monitor patients remotely.

Although telehealth
opens the doors to a more efficient healthcare delivery market, there are some
issues that still need to be addressed. One issue is the risk that pursuing
telehealth may lead to a breakdown in physician-patient relationships due to the
lack of consultations and in-person meetings.Because patients can meet remotely with their doctors via electronic
devices, there is less of an incentive to do in-person consultations. The lack of incentive for in-person
consultations can affect the quality of the consultation that the patient recieves.
In a Forbes Insights survey of business
executives, Forbes found that people did not devote their full attention during virtual meetings. Although telehealth deals with the healthcare
sector rather than the business sector, in-person meetings create an atmosphere
in which attendees pay more attention to each other. This lack of attention during virtual
consultations is of heightened importance because we are dealing with matters
of health. As such, full attention will
lead to better consultation and guidance. Another prominent issue is the concern over
reimbursements. Medicare reimburses telehealth
services related to real-time communications but not store-and-forward or
remote monitoring patient services. The
services commonly reimbursed are consultations, office visits, and some
physician fee schedule services, although restrictions do apply. Some states have begun to implement telehealth
coverage laws creating guidelines for reimbursements by Medicaid. These guidelines create a pathway for reimbursement for live video
telehealth, store-and-forward services, and at least some form of remote
patient monitoring. Lastly, one of the
greatest concerns has been telehealth parity laws. Telehealth parity laws demand reimbursements
by health insurance companies for telehealth services at the rate equal to
in-person services.This has created a
rift among supporters and opponents of telehealth. Those that support telehealth point to its
ability to improve healthcare delivery, while opponents argue that telehealth
should not be equated to in-person services to produce the same reimbursement
rates.

Regardless of what ones
opinion on telehealth, it is a growing area of healthcare that has already
begun to change the healthcare delivery landscape. The popularity of telehealth has led Congress
to consider the Medicare Telehealth Parity Act
of 2015, a nationwide telehealth parity law. The Act would entail an
expansion of the geographic locations in which telehealth services operate,
expand telehealth coverage for Medicare beneficiaries, and increase coverage of
telehealth services. Although the
chances of enactment are unclear, the fact that Congress is considering a
nationwide telehealth law illustrates the impact that telehealth is already
having on healthcare in the United States. Because of its potential to reduce healthcare
costs, improve access to healthcare, and better monitor patients, telehealth is
among the most attractive healthcare initiatives. As it becomes a more dominant part of
patients’ lives, additional state and federal guidelines will help shape the
structure of telehealth coverage in the American healthcare system.

Faizan A. Khan is a
third year law student at DePaul University College of Law. Mr. Khan graduated
cum laude from DePaul University with a Bachelor of Arts in Political Science
and minor In Economics. He is a currently serving on the DePaul Journal of
Health Care Law and will complete his J.D. in May 2017.